Medication Duloxetine Helps Reduce Pain From Chemotherapy

In A Majority Of Patients, Duloxetine Reduces Pain From Chemotherapy Treatment

In A Majority Of Patients, Duloxetine Reduces Pain From Chemotherapy Treatment

INTRO: An estimated 20 to 40 percent of cancer patients receiving certain types of chemotherapy treatments may experience debilitating pain. The pain can cause a number of symptoms including tingling, numbness, a shooting or burning sensation and even sensitivity to temperature. A new study examined whether the anti-depressant drug duloxetine, could help reduce this pain. Catherine Dolf has more in this weekâ€™s JAMA Report.

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David walking down hall, David in exam room with nurse, technician preparing chemo treatment in IV bag

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DAVID RONIS WAS DIAGNOSED WITH CANCER SIX YEARS AGO. AFTER HIS SURGERY HE UNDERWENT A SERIES OF CHEMOTHERAPY TREATMENTS. THE CHEMO CAUSED SOME PAINFUL SIDE EFFECTS.

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SOT/FULL Super @:11 David Ronis – Cancer Patient Runs:09

â€œThe symptoms for me were very extreme sensitivity to cold, in my hands and in my mouth.â€

DR. ELLEN LAVOIE SMITH FROM THE UNIVERSITY OF MICHIGAN SCHOOL OF NURSING AND CO-AUTHORS CONDUCTED A RANDOMIZED TRIAL WITH MORE THAN 230 PATIENTS WHO WERE STILL EXPERIENCING CHEMOTHERAPY RELATED PAIN AT LEAST THREE MONTHS AFTER THEIR TREATMENT ENDED. PATIENTS WERE RANDOMIZED TO RECEIVE THE ANTI-DEPRESSANT DRUG DULOXETINE OR A PLACEBO FOR FIVE WEEKS.

â€œThere was 41 percent of patients who did not respond but for the majority it is an effective treatment and this is great because to date there have been no studies that have demonstrated that really anything works.â€

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David with nurse, walking out

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DAVID HAS COMPLETED HIS CHEMOTHERAPY TREATMENTS AND SAYS EVEN THOUGH HE HAD TO DEAL WITH THE PAIN FROM HIS SENSITIVITY TO THE COLD, IT WAS WORTH IT.

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SOT/FULL Super @1:46 David Ronis – Cancer Patient Runs:07

â€œI felt that I was going to live and I look forward to a healthy rest of my life.â€

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CATHERINE DOLF, THE JAMA REPORT.

TAG: RESEARCHERS SAY STUDY PARTICIPANTS DID NOT EXPERIENCE ANY SERIOUS REACTIONS FROM THE DULOXETINE MEDICATION.

CHICAGO –Among patients with painful chemotherapy-induced peripheral neuropathy, use of the anti-depressant drug duloxetine for 5 weeks re­sulted in a greater reduction in pain compared with placebo, according to a study in the April 3 issue of JAMA.

“Approximately 20 percent to 40 percent of patients with cancer who re­ceive neurotoxic chemotherapy (e.g., taxanes, platinums, vinca alkaloids, bortezomib) will develop pain­ful chemotherapy-induced peripheral neuropathy. Painful chemotherapy-induced neuropathy can persist from months to years beyond chemotherapy completion, causing significant challenges for cancer survivors due to its negative in­fluence on function and quality of life. Chemotherapy-induced pe­ripheral neuropathy is difficult to manage, and most randomized controlled trials testing a variety of drugs with diverse mechanisms of action revealed no effective treatment,” according to background information in the article.

There is evidence that serotonin and norepinephrine dual reuptake inhibitors are effective in treat­ing neuropathy-related pain. Several phase 3 stud­ies have shown that duloxetine is an effec­tive treatment for painful diabetic neu­ropathy.

Ellen M. Lavoie Smith, Ph.D., of the University of Michigan School of Nursing, Ann Arbor, and colleagues conducted a ran­domized phase 3 trial to examine whether duloxetine would lessen chemotherapy-induced peripheral neuropathic pain. The study included 231 patients who were 25 years or older being treated at community and academic settings between April 2008 and March 2011. Study follow-up was com­pleted July 2012. Stratified by chemotherapeutic drug and comorbid pain risk, pa­tients were randomized to receive either duloxetine followed by placebo or placebo followed by duloxetine. Eligibility required that patients have a pain score of at least 4 on a scale of 0 to 10, representing average chemotherapy-induced pain, after paclitaxel, other taxane, or oxaliplatin treatment.

The initial treatment consisted of taking 1 capsule daily of either 30 mg of duloxetine or placebo for the first week and 2 capsules of either 30 mg of du­loxetine or placebo daily for 4 additional weeks.

The researchers found that at the end of the initial treatment pe­riod, patients in the duloxetine-first group reported a larger decrease in av­erage pain (average change score, 1.06) than those in the placebo-first group (average change score 0.34). The observed average differ­ence in the average pain score between the duloxetine-first and placebo-first groups was 0.73. Of the patients treated with dulox­etine first, 59 percent reported any decrease in pain vs. 38 percent of patients treated with placebo first. Thirty percent of duloxetine-treated patients reported no change in pain and 10 percent reported in­creased pain.

The authors note that the results sug­gested that patients who received plati­nums (oxaliplatin) may have experienced more benefit from duloxetine than those who received taxanes.

Pain-related quality-of-life im­proved to a greater degree for those treated with duloxetine during the ini­tial treatment than for those treated with placebo.

“In conclusion, 5 weeks of duloxetine treatment was associated with a statisti­cally and clinically significant improve­ment in pain compared with placebo. Exploratory analyses raise the possibility that duloxetine may work better for oxaliplatin-induced rather than taxane-induced painful chemotherapy-induced peripheral neuropathy,” the researchers write.

Editor’s Note: This study was supported by a grant from the NCI Division of Cancer Preven­tion, the Alliance Statistics and Data Center, and the Alliance Chairman. Drug and placebo were supplied by Eli Lilly. The NCI provided funding for data man­agement and statistical analysis. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

There will also be a digital news release available for this study, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, April 2 at this link.

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